blood banking science

1. Introduction into
Blood Banking
Dr. Amany M. Elshamy
Lecturer of Biochemistry and
Molecular Diagnostics
PH.D of Biochemistry and
Molecular biology
MLS, AUC, Cairo

2. OUTLINES

3. Introduction
Blood banking refers to the process of collecting, separating,
and storing blood. The first U.S. blood bank was established
in 1936.
Blood banking is the process that takes place in the lab to
make sure that donated blood, or blood products, are safe
before they are used in blood transfusions and other medical
procedures.
Blood banking includes typing the blood for transfusion and
testing for infectious diseases.

4. Introduction
According to the American Association of Blood Banks
(2013):
•About 36,000 units of blood are needed every day.
•The number of blood units donated is about 13.6
million a year.
•About 6.8 million volunteers are blood donors each
year.
•Each unit of blood is broken down into components,
such as red blood cells, plasma, cryoprecipitated
AHF, and platelets. One unit of whole blood, once it's
separated, may be transfused to several patients, each
with different needs.
•Annually, more than 21 million blood components are
transfused.

5. Blood types
According to the American Association
of Blood Banks, the distribution of
blood types in the U.S. includes the
following:
•O Rh-positive - 39%
•A Rh-positive - 31%
•B Rh-positive - 9%
•O Rh-negative - 9%
•A Rh-negative - 6%
•AB Rh-positive - 3%
•B Rh-negative - 2%
•AB Rh-negative - 1%

6. QUICK REVISION

7. Immunohaematology (Antigen)
• Antigen is a substance, which
elicits immune response. It is a
complex molecule whose
molecular weight exceeds 10000
daltons.
• The ABH antigens are
glycolipids while Rh antigens
are protein.

8. RBCs antigen
• The main two blood groups are called
ABO (with blood types A, B, AB, and O)
and Rh (with Rh D-positive or Rh D-
negative blood types).
• The RhD gene encodes the D antigen,
which is a large protein on the red blood
cell membrane. Some people have a version
of the gene that does not produce D
antigen, and therefore the RhD protein is
absent from their red blood cells.

9. RBCs
antigen

10. RBCs antigens

11. RBCs antigen
A, B, H antigens (ABO group).
RhD carries the D (Rh1) antigen and Rh
CE carries the C, c, E, and e.
Rh blood group system consists of at
least 45 independent antigens.
Clinical significance: hemolysis (
Hemolytic transfusion Rx and Hemolytic
disease of fetus and newborn).

12. Note
If a person has blood group O, the H antigen remains
unmodified. Therefore, the H antigen is present in the
highest amounts in blood type O and in the least
amounts in blood type AB.
Depending upon a person's ABO blood type, the H
antigen is converted into either the A antigen, B
antigen, or both.
The H antigen is produced by a specific
fucosyltransferase.

13. RBCs antigen

14. WBCs antigens
• Human leukocyte antigens (HLA) are genes in major histocompatibility
complexes (MHC) that help code for proteins that differentiate between
self and non-self. They play a significant role in disease and immune
defense.

15. PLTs antigens

16. PLTs antigens

17. Immunohaematology (antibody)
The antibodies are immunoglobulin in nature.
Approximately 82-96% of antibodies are polypeptide, and the rest 4-18% are carbohydrates
in nature.
The blood group antibodies are commonly, IgM, IgG or IgA.
Note; They react at room temperature (20-24°C).
The IgM are highly effective agglutinins and are capable of activating the complement.
Plasma contains significant amounts of IgM.polypeptides

18. Immunohaematology (antibody)
• The antibodies, which are produced without any antigenic
stimulus, are known as complete antibodies. Most IgM class
antibodies fall in this category. They are capable of agglutinating
red cells suspended in normal saline at 20-25°C. Most of the
ABH antibodies are IgM in nature and called natural or
complete antibodies.
• The antibodies that require a bridge like the Coomb’s molecule
for binding to the antigenic site are called incomplete
antibodies. Most IgG antibodies are incomplete antibodies. They
react at 37°C. The Rh are incomplete or acquired antibodies.

21. Grades of
agglutination
• The agglutination results are graded from
1+ to 4+. The American Association of
Blood Banks (AABB) recommends the
following grading system:
• 4+ = One solid aggregate of red cells
• 3+ = Several large aggregates
• 2+ = Medium sized aggregates with a clear
background
• 1+ = Small aggregates with a turbid
background giving granular appearance.
• Weak (w) = Tiny aggregates are seen only
under microscope
• Negative = All cells are free.

23. Haemolysis
The antigen and antibody
reaction where
complement is activated
leading to breakdown of
red cells and release of
haemoglobin is called
haemolysis.

24. Complements
The complements are plasma
proteins that interact with
bound antibodies resulting in
cell lysis and enhanced
phagocytosis. The nine
components of complements
are designated from C1 to C9.
The complements are
destroyed when heated with
anticoagulants to 56°C for
30 minutes.

25. COMPLEMENTS

26. Sensitization
The sensitisation is
defined as binding of
antigen and antibody,
in vitro or in vivo, with or
without agglutination.
Whenever the sensitised
cells come into contact
of each other, the result
is clumping of red cells
known as agglutination.

27. SENSITIZATION

28. LABORATORY EXAMINATION
BEFORE DONATION

29. Hb level
• Haemoglobin should be measured at each donation,
preferably before collection.
• Abnormally high and abnormally low hemoglobin values
should be confirmed by a full blood count on a venous
sample and, if appropriate, subsequently investigated.

30. Iron stores
• It is recognised that blood donation may result in iron
deficiency in repeat blood donors. This problem may arise
without it being evident through pre-donation haemoglobin
measurements.
• This may be especially important in women of childbearing
age and donors with inadequate dietary iron intake.

31. Standard tests
Certain sets of standard tests are
done in the lab once blood is
donated, including, but not limited
to, the following:
•Typing: ABO group (blood type)
•Rh typing (positive or negative
antigen)
•Screening for any unexpected red
blood cell antibodies that may cause
problems in the recipient

32. Standard tests
•Screening for current or past infections, including:
• Hepatitis viruses B and C
• Human immunodeficiency virus (HIV)
• Human T-lymphotropic viruses (HTLV) I and II
• Syphilis
• West Nile virus (is the leading cause of
mosquito-borne disease)
• Chagas disease (Chagas disease is caused
by the parasite Trypanosoma cruzi)

33. THE COMPONENTS OF BLOOD IN
BLOOD BANKING LAB

34. The components of blood
While blood, or one of its components, may be transferred, each
component serves many functions, including the following:
•Red blood cells. These cells carry oxygen to the tissues in the body
and are commonly used in the treatment of anemia.
•Platelets. They help the blood to clot and are used in the treatment
leukemia and other forms of cancer.
•White blood cells. These cells help to fight infection, and aid in the
immune process.

35. The components of blood
•Plasma. The watery, liquid part of the blood in which the
red blood cells, white blood cells, and platelets are
suspended.
•Plasma serves many functions, including the following:
• Helps to maintain blood pressure
• Provides proteins for blood clotting
• Balances the levels of sodium and potassium

36. The components of blood
•Cryoprecipitate AHF. The portion of
the plasma that contains clotting
factors that help to control bleeding.
• Albumin, immune globulins, and
clotting factor concentrates may
also be separated and processed for
transfusions.

37. REQUIREMENTS

38. 1. Donation Procedure
• The FDA regulates the collection, storage, and transfer of donated
blood.
• A reliable source of blood is critical to providing effective blood
products to recipients.
• The donation process begins with a screening procedure to
determine if the donor is healthy and has no conditions that would
make his or her donation hazardous.
• Donors are asked about their general health, as well as their travel
history and possible past exposure of blood-transmitted diseases,

39. Principles of blood collection
• Records should be kept for each activity associated with the
donation.
• The record should also reflect any unsuccessful donation,
the rejection of a donor, adverse reactions or unexpected
events. A qualified health professional should sign the donor
selection records and the final assessment.
• Sterile collection systems should be used by the instructions
of the manufacturer

40. Donation
A simple physical, including blood pressure, pulse rate, and
temperature, is used to rule out other risks.
This physical will also look for signs of any of the blood-
transmitted diseases that might increase recipient risk.
A simple laboratory measurement is used to make sure that the
blood donation will not make the donor anemic.

41. Special
attention
Special attention should be given to the following conditions:
• abnormal bleeding episodes;
• a history suggestive of fluid retention (of special interest if
steroids and/or plasma expanders are to be used);
• intake of drugs containing acetylsalicylic acid or other
platelet inhibiting components. Platelet apheresis should not
be undertaken within 48 h after the last intake of
acetylsalicylic acid or piroxicam;
• a history of gastric symptoms (if steroids are to be used);
• adverse reactions to previous donations.

42. Donation
• If the donor is found suitable for
donating blood, approximately it is
generally accepted that the volume of
whole blood donated should not exceed
13% of blood volume: e.g. a donor
should weigh at least 45 kg to donate
350 ml (± 10%) or 50 kg to donate 450
ml ± 10% (67,68).

43. Donation
It is generally accepted that all men weighing
≥ 50 kg have a sufficiently large blood volume
to donate a total 535 mL of blood (500 mL plus
35 mL for testing and retention of a donation
sample), whilst all women weighing ≥ 50 kg
have a sufficiently large blood volume to
donate a total 485 mL of blood (450 mL plus
35 mL for testing and retention of a donation
sample).

46. Donation
The donor will produce
replacement fluid for
the blood donation
within 24 hours and
red blood cells in four
to six weeks.
At least eight weeks
between donations are
therefore required for
whole blood donations.

47. Principles of blood
collection
Premises for donor sessions.
Equipment used at blood
donation sessions.
Pre-donation checks and
labeling.
Venipuncture and proper
mixing.
Management of adverse
reactions in donors.
Donor clinic documentation.

48. Blood Safety and
Matching
On their surface, red cells have inherited
chemical structures called antigens that can
cause a person’s immune system to make
antibodies against them.
Humans have 35 major groups or families of
these antigens, as well as other minor groups,
but consideration of two, the ABO group and the
RhD group, is very important to ensure that a
transfusion recipient receives compatible blood.
The presence of antigens within these groups is
what determines a person’s blood type.
Blood types are referred to as Type A, Type B,
Type AB (which has both A and B antigens), or
Type O (which has neither A or B antigens)
followed by positive or negative, which indicates
the presence of the RhD antigen. Persons who
are RhD negative have no RhD antigen

51. Blood Safety and Matching
• Antibodies in the plasma of donors with
different blood types cause a reverse
situation.
• For example, since a person with Type
AB blood makes no antibodies
against Type A or Type B cells, his or
her plasma can be given to a person
with Type A, Type B, Type AB, or
Type O blood.

52. Blood Safety and Matching
• In emergencies, when the recipient’s blood type is unknown,
the person can receive type O negative red cells without
producing an ABO or RhD incompatibility reaction.
• In other situations, even non-emergent, where the recipient’s
specific blood type is known but there is no type-specific
blood available, a compatible type may be used if
determined to be compatible by cross-matching.
• Cross-matching is a simple and commonly practiced
laboratory test that verifies blood compatibility.

53. Storage of blood components
Storage conditions for
blood components are
designed to preserve
optimal viability and
functionality during the
entire storage period.
The risk of bacterial
contamination
decreases substantially
if only closed separation
and storage systems
are used.

54. Srorage
Red cell configurations R1 to R4 maintain components within a
temperature range of 2 ºC to 10 ºC.
Platelet configurations P1 and P2 maintain components within a
temperature range of 20 ºC to 24 ºC.
Frozen component configurations F1 and F2 maintain components at
–25 ºC. Configuration F2 requires dry ice.
Data loggers are used to continually record the internal
temperature for shipments if the anticipated transport time is
expected to exceed the maximum transport time.

55. Transportation of blood components
• Blood components should be transported by a system that has been
validated to maintain the integrity of the component over the
proposed maximum time.
• It is recommended that some form of temperature indicator on receipt
can be monitored as follows:
• • place a thermometer between the bags and fix them together with
rubber bands;
• • quickly place them back into the container and close the lid;
• • read the temperature after 5 minutes.

56. EQUIPMENT

59. Blood
mixer

60. plasma
expressor
plasma
freezer
plasma
thawing
bath

61. 3. Recipient
Safety
Risks for a person receiving
blood can be divided into
several categories, which
include reactions due to
incompatible blood types,
allergic reactions, and
infections in the donated blood.

62. Allergic and Other Reactions
• Delayed hemolytic reactions may occur if the recipient makes
antibodies against minor antigens on the transfused red cells.
• Delayed hemolytic reactions occur days to weeks following a transfusion,
characterized by mild anemia and/or hyperbilirubinemia.
• Such reactions are usually mild and are caused by certain chemicals
in the donor’s blood; these may cause fever, hives, rashes, itching,
low blood pressure, and similar symptoms.
• In rare instances, patients receiving massive blood transfusions may
develop transfusion-associated acute lung injury, which is caused by
an inflammatory reaction to large amounts of foreign chemicals in the
donor’s blood.

63. E X A M P L E S O F
A D V E R S E
R E A C T I O N S
R E L AT E D T O
B L O O D
C O L L E C T I O N

64. E X A M P L E S O F
A D V E R S E
R E A C T I O N S
R E L AT E D T O
B L O O D
C O L L E C T I O N

65. Question
A blood transfusion is when a person receives donated blood. Why are transfusions gi
A. To increase the amount of blood
B. To increase the blood's ability to carry oxygen
C. To decrease the risk of bleeding
D. All of the above
2
. Which parts of the blood can be transfused?
A. Whole blood
B. Platelets
C. Red blood cells
D. All of the above

66. What is the minimum you should weigh to donate blood?
A. 50 kg
B. 60 kg
C. 70kg
D. 80kg

67. How often can a donor give blood?
A .At any time
B .Every 2 months
C .Every 4 months
D .Every 6 months
What are the common risks of donating blood?
A. Contract common viruses
B. Bacterial infection
C. Low blood pressure
D. None of the above

68. Donated blood undergoes screening for which diseases?
A. HIV (the virus that causes AIDS)
B. Viral hepatitis
C. Diabetes
D. A and B
.Which agency regulates blood donation?
A. American Medical Association
B. U.S. Health and Human Services
C. FDA
D. American Red Cross

69. An advisory panel of experts has suggested that anyone who
received transfusions before March 1992 be screened for which of
these diseases?
A. HIV
B. Hepatitis C
C. Mononucleosis
D. Leukemia
Which is the most common blood type among human population?
A. O positive
B. O negative
C. AB positive
D. AB negative

70. •Which one of the following constitutes the permanent rejection
status of a donor?
• A. A tattoo 5 months previously
• B. Recent close contact with a patient with viral hepatitis
• C. 2 units of blood transfused 4 months previously
• D. Confirmed positive test for HBsAg 10 years previously

71. •According to AABB standards, which of the following donors
may be accepted as a blood donor?
• A. Traveled to an area endemic for malaria 9 months previously
• B. Spontaneous abortion at 2 months of pregnancy, 2 month
previously
• C. Resides with a known hepatitis patient
• D. Received a blood transfusion 72 weeks previously months

72. • For apheresis donors who donate platelets more
frequently than every 4 weeks must be performed prior
to the procedure and be at least:
• A. 150 x 10^3/ul (150 x 10^9/L)
• B. 200 x 10^3/ul (200 x 10^9/L)
• C. 250 x 10^3/ul (250 x 10^9/L)
• D. 300 x 10^3/ul (300 x 10^9/L

73. •Which part of the blood can be transfused?
• A.RBCs
• B.Whole blood
• C.Platelets
• D.All of the above
•1 unit will raise Hb by how much?
• A. 0.25-0.75g/dL
• B.0.75-1.2g/dL
• C.1-1.5g/dL
• D.None of the above
•The liquid part of blood is called
• A.Red Blood Cells
• B.Plasma
• C.White Blood Cells
• D.Platelet